Laser Treatment Of Port Wine Stains Research Articles

DERMOSCOPY FEATURES OF PORT-WINE STAINS: THE FIRST STUDY OF 148 CASES IN VIET NAM

Introduction: Port-wine stains (PWS) are capillary malformation affecting 0.3% to 0.5% of the population. In Vietnam, the dermoscopic features of PWS have not been systematically studied.Objectives: The aim of this study was to analyze the dermoscopic images of 148 patients with PWS. Methods: 148 cases with PWS were analyzed basing on dermascopic images.Results: The most common vascular images were dots or globules vessels (76.4%) and linear vessels (68.9%). Sausage-like vessels and whitish veils were more common in the group of patients aged older than 18 years or with purple type of PWS. For all the dermoscopic features of PWS, excluding linear vessels, there were no significant differences between lesions located in the central facial area and peripheral facial area (p > 0.05). Compared with the peripheral facial lesions, linear vessels were more common in central facial lesions (p < 0.05). Conclusion: Dermoscopy may provide very useful clinical information before laser treatment of PWS. The vascular manifestations of PWS determined by dermoscopy may correlate with age, colour, location and response to laser treatment.

Treating pediatric port-wine stains in aesthetics

A port-wine stain (PWS) is a vascular birthmark present in 0.3% to 0.5% of newborns. If untreated, this erythematous patch will grow proportionally with the child to thicken and darken with age. PWSs have implications for the child’s quality of life for many years, with cosmetic, medical, and psychosocial disability. Controversy exists in many aspects surrounding laser treatment of these birthmarks in the pediatric population. We have reviewed the clinical features as well as the historic and current laser treatment of PWS. We have also examined the current hot topics of debate surrounding the treatment of PWS in the pediatric population. These controversies include the patient age of treatment initiation, the long-term psychologic impact, the use of general anesthesia, the application of eye shields, and alternative treatments for recalcitrant PWS. We have concluded with a discussion on the future directions of management and treatment.

Recurrent pyogenic granuloma within a port wine stain

<p class="abstract">Pyogenic granuloma (PG) is a common vascular growth usually seen on the face and extremities following trauma, drugs like retinoids, antineoplastic agents or pregnancy. PG and port-wine stain (PWS) represent different types of vascular lesions that may rarely occur in association. PG arising in a PWS is usually reported following trauma, pregnancy or laser treatment of PWS. Any growth in a long-standing vascular lesion creates panic in the patient and a challenge to the physician, especially in the head and neck area. We report a case of recurrent PG emerging de novo in three different locations within the same PWS in a 24 year old male. A review of literature about the coexistence of both conditions is presented here, together with dermoscopic features.</p>

Assessment of Outcomes With Pulsed Dye Laser Treatment of Port-Wine Stains Located Proximally vs Distally on Extremities

This nonrandomized clinical trial evaluates the morphological and anatomical features of port-wine stains treated by pulsed dye laser to assess differences in treatment efficacy based on proximal vs distal location on extremities.

Pulsed Dye Laser Treatment of Port-Wine Stains in Infancy Without the Need for General Anesthesia

Recent concerns regarding repetitive use of general anesthesia in children younger than 3 years have placed greater importance on the controversy surrounding the timing of the initiation of port-wine stain (PWS) laser treatment. To evaluate the use of PWS treatments at the age of 1 year or younger in the office setting without general anesthesia. Retrospective cohort study based on medical record reviews at a single, high-volume laser center for children who started pulsed dye laser treatment at the age of 1 year or younger for their PWS between 2000 and 2017. The data cutoff was at 1 year after the initial treatment to have comparable data points. The primary outcome was improvement of PWSs using before and after photographs, which were reviewed by 4 physicians independently and graded using the following 5-point visual analog scale (VAS): poor (grade 1: 0%-25% improvement), fair (grade 2: 26%-50% improvement), good (grade 3: 51%-75% improvement), excellent (grade 4: 76%-99% improvement), and complete (grade 5: 100% improvement) clearance. Of the 197 patients (73 [37.1%] boys; 124 [62.9%] girls), most (149 [75.6%]) had facial lesions. The mean age at the time of first treatment was 3.38 months (range, 5-355 days) and the mean number of treatments was 9.8 (range, 2-23; median, 10). Per the mean physician VAS grading of 197 patients, 51 patients (25.9%) showed 100% clearance (mean [range] VAS score of 4.78 [4.5 - 5]); 81 patients (41.1%) showed 76 to 99% improvement (mean [range] VAS score of 3.91 [3.5 to <4.5]); 44 patients (22.3%) showed 51% to 75% improvement (mean [range] VAS score of 2.86 [2.5 to <3.5]); 13 patients (6.6%) showed 26% to 50% improvement (mean [range] VAS score of 2.12 [1.5 to <2.5]); and 8 patients (4.1%) showed 0 to 25% improvement (mean [range] VAS score of 0.78 [0 to <1.5]). The presence of a V1 (first branch of the trigeminal nerve [ophthalmic nerve]) lesion was associated with a statistically significantly higher clearance rate by a VAS grade of 0.55 (95% CI, 0.25-0.84; P < .001). The mean (SD) VAS grade for all patients was 3.65 (1.26), corresponding to excellent clearance. None of the patients experienced scarring or permanent pigmentary change. In this study, treatment of PWSs in infancy was both safe and effective. Early intervention allows for treatment without general anesthesia, maximizing the chance to achieve clearance before school age and thereby minimizing the negative outcome of PWSs for both the patient and the family.

Correction to: Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study.

In the originally published article, the title was incorrectly copied from another article. The correct title is "Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study", which is also shown above.

Intravenous injection of artificial red cells and subsequent dye laser irradiation causes deep vessel impairment in an animal model of port-wine stain.

Our previous study proposed using artificial blood cells (hemoglobin vesicles, Hb-Vs) as photosensitizers in dye laser treatment for port-wine stains (PWSs). Dye laser photons are absorbed by red blood cells (RBCs) and hemoglobin (Hb) mixture, which potentially produce more heat and photocoagulation and effectively destroy endothelial cells. Hb-Vs combination therapy will improve clinical outcomes of dye laser treatment for PWSs because very small vessels do not contain sufficient RBCs and they are poor absorbers/heaters of lasers. In the present study, we analyzed the relationship between vessel depth from the skin surface and vessel distraction through dye laser irradiation following intravenous Hb-Vs injection using a chicken wattle model. Hb-Vs were administered and chicken wattles underwent high-energy irradiation at energy higher than in the previous experiments. Hb-Vs location in the vessel lumen was identified to explain its photosensitizer effect using human Hb immunostaining of the irradiated wattles. Laser irradiation with Hb-Vs can effectively destroy deep vessels in animal models. Hb-Vs tend to flow in the marginal zone of both small and large vessels. Increasing laser power combined with Hb-Vs injection contributed for deep vessel impairment because of the synergetic effect of both methods. Newly added Hb tended to flow near the target endothelial cells of the laser treatment. In Hb-Vs and RBC mixture, heat transfer to endothelial cells from absorbers/heater may increase. Hb-Vs function as photosensitizers to destroy deep vessels within a restricted distance that the photon can reach.

Gold nanospheres enhanced photothermal therapy in a rat model.

Efficient photothermal conversion of gold nanoparticles with strong light absorption suggests their wide use as selective photothermal agents in biomedical fields. The aim of this study is to investigate the use of gold nanospheres (GNPs) as exogenous visible light absorbers to improve laser treatment of port-wine stains. Thiol-terminated methoxypolyethylene glycol modified GNPs (PEG-GNPs) with peak extinction matching the visible light wavelength of the laser being used were synthesized. An in vitro capillary experiment was prepared to investigate the thermal response of blood vessels with and without injection of 4.54 mg PEG-GNPs in mice prior to irradiation by a frequency-doubled Nd:YAG laser at a wavelength of 532 nm. The in vitro results demonstrated that the photocoagulation size in blood vessels after exposed to laser light increased with the increment of concentration of PEG-GNPs in blood within a certain range. However, the unwanted thermal response (i.e., cavitation) occurred when the concentration of PEG-GNPs in blood was larger than 2.5 mg/ml. The in vivo results suggested that more obvious blood thermal response can be induced by laser light after injection of PEG-GNPs. After injection of 4.54 mg PEG-GNPs, laser radiant exposure required for thread-like constriction of blood vessels decreased from 12.5 to 9.8 J/cm2 with the pulse duration of 10 ms, from 15 to 11.85 J/cm2 with the pulse duration of 30 ms, respectively. This in vitro and in vivo experimental results show that PEG-GNPs combined with laser light could be a promising modality to reduce the radiant exposure required for obvious blood thermal response, thereby providing a potential strategy for improving the laser treatment of cutaneous vascular lesions. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Pulsed-Dye Laser Treatment of Port-Wine Stains in Children: Useful Tips to Avoid General Anesthesia.

Pulsed dye laser (PDL) treatment of port-wine stains (PWSs) in children is a common procedure performed in most laser units. Pain assessment in our younger patients is a major concern, especially in those with extensive PWSs. The use of general anesthesia (GA) results in pain-free treatment, but its effects on the developing brain are far from totally understood. Thus we propose some tips that avoid the use of GA in most of our young patients, including the use of topical anesthetics and cooling systems, large laser spot size and high frequencies, early and frequent treatment with parents present, and the "introduction" and "pressure" techniques, among others.

An integral MPS model of blood coagulation by laser irradiation: Application to the optimization of multi-pulse Nd:YAG laser treatment of port-wine stains

The multi-pulse laser treatment of port-wine stains (PWS) has gained much attention owing to its considerable effect on deep and large PWS vessels and the less damage to the epidermis. To reveal the mechanism of the thermal damage to the vessels caused by the multi-pulse Nd:YAG laser, an integrated numerical model of the multi-pulse laser treatment of PWS was developed by combining the voxel-based Monte Carlo (VMC) method for light propagation calculation, the particle form of Pennes bioheat transfer model for heat transfer calculation, and the non-Newtonian moving particle semi-implicit (MPS) method for blood flow and coagulation. An in vitro experimental platform was constructed to visualize coagulation caused by multi-pulse Nd:YAG laser irradiation of the blood in a capillary tube. Numerical results of coagulation shape and area agreed well with experimental results, confirming the validity of the proposed model. Using this integrated model, the thermal damage mechanism of the multi-pulse Nd:YAG laser treatment of PWS was revealed: When a blood vessel is completely obstructed by coagulation, the blood flow is stopped, and subsequent laser pulses always irradiate the same coagulated area and the absorption of laser energy is increased; as a result, the thermal effects of subsequent laser pulses improve remarkably. Finally, the applicable range of the multi-pulse Nd:YAG laser and optimal laser parameters, including frequency, fluence, and pulse number, for clinical practice are recommended.

Artificial Red Blood Cells as Potential Photosensitizers in Dye Laser Treatment Against Port-Wine Stains.

We suggest a novel method that uses artificial blood cells (hemoglobin vesicles, Hb-Vs) as photosensitizers in dye laser treatment (at 595-nm wavelength) for port-wine stains (i.e., capillary malformations presenting as red birthmarks) based on the results of animal experiments. As compared with human red blood cells, Hb-Vs have the same absorbance of 595 nm wavelength light and produce the same level of heat following dye laser irradiation. Small sized Hb-Vs (250 nm) distribute in the plasma phase in blood and tend to flow in the marginal zone of microvessels. Intravenous injections of Hb-Vs caused the dilatation of microvessels, and dye laser treatment with Hb-Vs destroyed the vessel wall effectively. Following the intravenous injection of Hb-Vs, the microvessels contained more Hb that absorbed laser photons and produced heat. This extra Hb tended to flow near the endothelial cells, which were the target of the laser treatment. These attributes of Hb-Vs will potentially contribute to enhancing the efficacy of dye laser treatment for port-wine stains. Hemoglobin is a type of porphyrin. Thus, our proposed treatment may have aspects of photodynamic therapy using porphyrin that leads to a cytotoxicity effect by active oxygen.

Influence of laser wavelength on the thermal responses of port wine stain lesions in light, moderate and heavy pigmented skin

Abstract Pulsed dye laser (PDL) in visible band (e.g. 585 or 595 nm) together with cryogen spray cooling has become the golden standard for treatment of vascular malformation such as port wine stain (PWS). However, due to the limited energy penetration depth of the PDL, deeply buried blood vessels are likely to survive from the laser irradiation. Nd:YAG laser in near infrared (1064 nm) has great potential in the laser treatment of PWS due to its deeper penetration depth. In this study, the influence of laser wavelength in treating PWS lesions with various melanin concentrations in epidermis was theoretically investigated by a two-temperature model following the local thermal non-equilibrium theory of porous media. The results showed that deeply buried blood vessels can be coagulated by dual-wavelength laser combing 585 or 595 nm with 1064 nm laser. Furthermore, the therapeutic results by dual-wavelength laser were highly related to the melanin concentration in epidermis. In the light and moderate pigmented skin, the 595/1064 nm dual-wavelength laser showed better treatment effect in treating PWS with deeply-buried blood vessels than of 585/1064 nm dual-wavelength laser. For a high pigmented skin, the 585/1064 nm dual-wavelength laser showed better treatment effect than 595/1064 nm dual-wavelength laser.

The Effectiveness of Port wine Stain Laser Treatment in Children

Introduction . Vascular malformations in children tend to be a serious problem because the absence of timely and adequate treatment can lead to the functional, cosmetic, psychological disorders and social disadaptation of the patients. Pulsed dye laser (PDL) is the «gold standard» of port wine stain therapy in children. Patients and Methods . 225 patients aged from 2 weeks to 12 years received treatment performed at the Research Institute of Pediatric Oncology and Hematology at FSBI “N.N. Blokhin Russian Cancer Research Center” of the Ministry of Health of the Russian federation using pulsed dye laser (wavelength 595 nm). Results . The analysis of the PDL therapy results detected the overall lightening of 80% after the initial treatment. Satisfactory results were observed in 18.7% of patients and 0.9% had bad results. No response the treatment due to the deep vascular lesions was observed in 1 patient with the Klippel−Trenaunay syndrome. No complications were registered in this cohort. Conclusion . The results of the study demonstrated high effectiveness of the PDL therapy in children. A multimodal approach to the diagnosis and treatment of patients with vascular malformations at large medical institutions provides a unique synthesis of academic and practical cooperation between specialists from different departments and the realization of individual treatment regimens.

単純性血管腫に対する色素レーザー治療と問題点

The pulsed-dye laser has been a first choice treatment of a port-wine stain (PWS) since a quarter century ago, and the long-pulsed dye laser with a cold air cooling system is seen as the gold standard treatment for a PWS currently. Selectively the laser irradiation damaged an ectatic blood vessels of PWS without scarring, but the dye laser were limited to a depth and diameter of ectatic blood vessels. We observed significant redarkening of a PWS at long-term follow up after the dye laser therapy. Finally practical problems in dye laser treatment of PWS were discussed.

Laser treatment of port-wine stains.

Port-wine stains are a type of capillary malformation affecting 0.3% to 0.5% of the population. Port-wine stains present at birth as pink to erythematous patches on the skin and/or mucosa. Without treatment, the patches typically darken with age and may eventually develop nodular thickening or associated pyogenic granuloma. Laser and light treatments provide improvement through selective destruction of vasculature. A variety of vascular-selective lasers may be employed, with the pulsed dye laser being the most common and well studied. Early treatment produces more optimal results. Advances in imaging and laser treatment technologies demonstrate potential to further improve clinical outcomes.

Variables affecting clinical response to treatment of facial port-wine stains by flash lamp-pumped pulsed dye laser: the importance of looking beyond the skin

The response of port-wine stains (PWS) to conventional laser treatment in adults is difficult to predict. To assess the influence of local or systemic hemodynamic variables on the clearance of PWS by using flash lamp-pumped pulsed (FLPP) dye laser. All consecutive patients ages 18 years or older undergoing laser treatment for a facial PWS were eligible. Laser sessions were scheduled every 8 weeks. All patients were evaluated based on a standard scale with four evaluation categories, from no or minimal improvement to total or almost total clearance. Clearance was achieved by 50.1 % (95 % confidence interval 35.6-64.7) of patients after a maximum of 15 treatment sessions. In multivariate analysis, increased age, a newly described Type III capillaroscopic pattern, and presence of lesions in dermatome V2 were all associated with a reduced clinical response to treatment. In a model restricted to demographic pattern and patient characteristics, arterial hypertension was also associated with a lower clinical response. A strong association was found between arterial hypertension and the Type III capillaroscopic pattern. Age, arterial hypertension, capillaroscopic pattern, and body location should be considered when planning laser treatment of PWS.

The assessment of pulsed dye laser treatment of port-wine stains with reflectance confocal microscopy

Background: Reflectance confocal microscopy (RCM) is a noninvasive technique for evaluating cutaneous lesions with cellular level resolution close to conventional histopathology. The aim of this study is to observe the vascular changes in Port-wine (PWS) lesions and assess the clinical efficacy of Pulsed Dye Laser (PDL) treatment by examining vessel diameter and density with RCM. Materials and methods: Eleven adult patients with PWS, each had four test patches carried out with different pulse durations (1.5, 3, 6, and 10 ms), respectively; fluences of 9–12 J/cm2; and a spot size of 7 mm. The PDL treatment was repeated 3–5 times at a 2-month interval. Photographs and measurements with RCM were taken before each treatment and 2 months after the last treatment. Results: The PDL treatment exhibited increasing clearance with reducing pulse durations. Vessel diameters and densities were significantly decreased in the same pulse-duration groups after treatment. There was significant difference between 1.5 ms pulse-duration group and other pulse-duration groups in reducing blood vessel diameter at the depth of 150 μm. Conclusions: RCM can be used to assess the clinical efficacy of PDL treatment.

Quantitative three‐dimensional assessment of port‐wine stain clearance after laser treatments

Outcomes analysis of laser treatment for port-wine stains (PWS) has been hampered by the lack of an objective measure of surface area and volume; moreover, treatment success is often gauged by clinician subjective assessment. Three-dimensional (3D) surface imaging has been applied in several medical disciplines to quantify surface changes, with promising results. We hypothesized that 3D surface imaging could be used to objectively measure changes in area and volume of PWS following laser treatment. We performed a retrospective review of consecutive patients with PWS treated over a 20-month time period. Area and volume of the lesions were measured using 3dMD photogrammetric software (3dMD; Atlanta, GA) before and after a series of sequential pulsed dye laser and/or alexandrite laser treatments. Fifty-five patients with 59 PWS were included in the study. The initial average measured area was 45.6 cm(2) ; final average measured area decreased to 34.6 cm(2) (P < 0.001). The average volume change was 1.20 ml for all PWS included in the study and 1.90 ml for lesions that received at least five laser treatments within the study period. Three-dimensional photography demonstrated area and volume changes in patients with PWS after laser treatments. Future studies to determine if statistically significant changes correlate with clinically appreciable changes are warranted.

Quantitative three‐dimensional assessment of port‐wine stain clearance after laser treatments

Outcomes analysis of laser treatment for port-wine stains has been hampered by the lack of an objective measure of surface area and volume; moreover, treatment success is often gauged by clinician subjective assessment. Three-dimensional (3D) surface imaging has been applied in several medical disciplines to quantify surface changes, with promising results. We hypothesized that 3D surface imaging could be used to objectively measure changes in area and volume of port-wine stains following laser treatment. We performed a retrospective review of consecutive patients with port-wine stains treated over a 20-month time period. Area and volume of the lesions were measured using 3dMD photogrammetric software (3dMD, Atlanta, GA) before and after a series of sequential pulsed dye laser and/or alexandrite laser treatments. Fifty-five patients with 59 port-wine stains were included in the study. The initial average measured area was 44.3 cm(2) ; final average measured area decreased to 36.9 cm(2) (P < 0.001). The average volume change was 1.20 cc for all PWS included in the study and 1.90 cc for lesions that received at least 5 laser treatments within the study period. Three-dimensional photography demonstrated area and volume changes in patients with port-wine stains after laser treatments. Future studies to determine if statistically significant changes correlate with clinically appreciable changes are warranted.

Indocyanine green-augmented diode laser treatment of port-wine stains: clinical and histological evidence for a new treatment option from a randomized controlled trial

Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem. To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL). In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λ(em)=585 nm, 6 J cm(-2) , 0.45 ms pulse duration) and ICG+DL (λ(em)=810 nm, 20-50 J cm(-2) , 10-25 ms pulse duration, ICG-concentration: 2 mg kg(-1) body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment. ICG+DL therapy induced photocoagulation of medium and large blood vessels (>20 μm diameter) but not of small blood vessels. According to the investigators' assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P=0.114, P=0.291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P=0.003, P=0.006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5.81 ± 2.12) than FPDL treatment (1.61 ± 1.84). ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.